Details Title: 000 Kettering C Description: Kettering airway care Total Flash Cards: 109 Created: 09/17/2009 15:54:45		New Users: To study from this flashcard set, or to create your own your own study flash cards, REGISTER HERE. Existing Users: CLICK HERE. Additional Health Care Flashcards
Cards in this set: Term What are clinical signs of a partial obstruction Definition noisy breathing - Inspiratory stridor, cough/gurgling or unilateral wheeze, paradoxical/unequal respirations, use of accessory muscles, increased pulse and blood pressure, diaphoresis, alteration of level of consciousness, cyanosis Term What are clinical signs of a complete obstruction Definition marked inspiratory efforts without air movement - cannot speak; marked sternal, intercostal and epigastric retractions accompanied by strong contractions of accessory neck muscles of ventilation, nasal flaring, supraclavicular retractions, marked distress and extremely anxious, agitated or combative, marked attempts to ventilate, so violent as to resemble a seizure Term Most common airway obstruction Definition tongue, any time unconscious this is possible (drug overdose, etc). Sometimes called soft tissue Term causes of upper airway obstruction Definition tonuge or soft tissue, inspissated secretions (thick and glue-like), laryngospasm, laryngeal or subglottic edema, foreign bodies - (food, toys, dentures) Term What is the most fundamental way to establish a patent airway Definition head tilt / chin lift Term What are contraindications to head tilt / chin lift Definition fractured neck (trauma?) Term What would you do if cannot do head tilt/ chin lift Definition jaw thrush or modified jaw thrust (modified is better, always modified) Term contraindications to abdominal thrust Definition markedly obese, obviously pregnant, infants, rib fractures Term What to do if cannot do an abdominal thrust Definition chest thrust Term When to use a nasal airway vs an oral airway Definition unconscious, oral airway; conscious and use nasal airway. Term What are the complications of an oral airway Definition This airway should be left unsecured, gagging, vomiting, laryngospasm, airway obstruction Term What are the complications of a nasal airway Definition trauma, epistaxis (nasal bleeding), increased airway resistance Term What are reasons for intubation Definition to ventilate, but also to keep a patent airway; i.e. at risk to throw up and aspirate (drowning, suspected drug overdose), lots of suctioning, to deliver medications (can't get IV started is hint that would need to give drugs down ET tube) Term What are drugs that can be instilled in the ET tube Definition NAVEL (narcan - narcotic OD, atropine - bradycardia, valium/versed-sedation, epinephrine - asystole, lidocaine - PVCs) - double normal IV dose Term Physiological and psychological alteration Definition by-pass normal filtration, humidification and warming, less effective cough, disrupts mucus transport, loss of dignity, unable to communicate Term What are the complications of Intubation Definition infection, fever, secretions, etc.; cuff pressure is directly related to capillary pressures and should be equal to or less than 20 torr. Laryngospasm (most serious), right mainstem bronchus intubation Term Briefly describe procedure of intubation Definition position patient's head in sniffing position; adequately hyperoxygenate (resus bag with 100% o2 for two minutes); hold laryngoscope in left hand, ET tube in right; insert blade down right side of mouth (to scoop tongue); advance blade, lift epiglottis, visualize cords, have suction available; insert tube and inflate the cuff to assess tube position - ventilate and oxygenate Term What is first and quickest way to assess ET tube position Definition bilateral chest movement Term What are the ways to assess ET tube position Definition bilateral chest movement first, auscultation, chest x-ray (2 cm or 1 inch above carina, right above aortic knotch); capnography or CO2 detector Term Tube Maintenance Definition suctioning, humidification, cuff pressure - minimal leak, minimal occulding volume, use high volume low pressure cuff Term Intubation blades, McIntosh vs Miller Definition McIntosh is curved like an apple, Miller is straight like the L's in Miller - Mcintosh adult typical; Miller infant typical Term Troubleshooting if light on blade doesn't work Definition check battery, bulb, blade Term What are blade sizes Definition Adult - 3, child 2, infant 1, pre-term 0 Term Stylet vs MaGill forceps Definition Stylet oral intubation only; magill forceps for nasal intubation only Term What is danger of stylet Definition must be kept approximately 1 cm above end of ET tube, top should be bent to prevent advancement Term ET tube sizes Definition correlete with weight in grams ; infant is 3; adult male about 8 and adult female about 7 Term ET tube markings for oral and nasal Definition Oral 21-25 (low to mid 20's) nasal 26-29 Term Cuff types Definition low pressure, high volume is preferred, pressure should not exceed 20 mmHg Term What is double lumen ET tube Definition one side into each side of lung - different features of each lung. i.e. trauma, lobectomy with one lung traumatized and one is normal; or want to lavage one lung - any scenario where one lung should be treated different than the other Term Combitube Definition EMT, emergency, first response - quick way to establish an airway (temprorary) Term laryngeal mask airway Definition surgical, and to establish permanent airway intubate through the tube and pull laryngeal mask up and over. Term How do you extubate Definition suction down the tube first (clean), then back of the throat (dirty) (below cuff and above cuff); deflate cuff; patient takes a deep breath in and pull tube out at peak inspiration (and to prevent damage to vocal cords); stand by and observe for adverse reactions Term What are extubation hazards Definition severe stress, severe stridor, marked distress - word severe major obstruction and re-intubate; moderate is not emergency and action is oxygenate, cool aerosol, and racemic epinephrine. Mild is no treatment, monitor Term indications of tracheostomy Definition preferred method of providing a/w for patients who require long-term ventilation; when upper airway obstruction prevents intubation; if not an emergency done carefully with sterile environment; easier to stabalize suction and tolerate; pt is able to eat and speak, fewer hazards and less airway resistance Term Tracheostomy complications Definition immediate (within 24 hours) bleeding, pnemothorax, air embolism, subcutaneous emphysema. Late (24-48) infection, hemorrhage, obstruction, TE Fistula Term When can the cuff be deflated Definition the patient is eating, patient is on positive pressure ventilation Term How often is trach tube changed Definition not more than once per week Term When would trach tube be changed more than once per week Definition obstructed - pull out, ventilate and insert a new one; tube too small (pressures too high to keep inflated); punctured cuff - unable to seal, would need to be replaced Term Care of trach after removal Definition do not suture stoma closed, apply sterile dressing and/or antibiotic, clean periodically with hydrogen peroxide, have patiet cough to clear secretions Term standard trach tubes Definition white plastic trach tube, may have inner cannula for easy cleaning, has a soft cuff Term fenestrated trach tube Definition has opening in outer cannula above the cuff, used for weaning and temporary mechanical ventilation with inner cannula, not used for code or in emergencies, when plugging the tube, be sure to deflate the cuff, remove inner cannula and then plug the trach tube, used for phonation Term tracheal button Definition used to maintain stoma, used in some sleep apnea cases, allows tracheal suction and phonation with least amount of airway resistance, uncuffec, cannot be utilized for resusitation Term laryngectomy Definition ripping out larynx due to something like throat cancer- no longer have upper airway and will have a trach stoma but tube out of neck called laryngectomy tube which is their new airway and cannot intubate. If on ventilator, would intubate through laryngectomy tube (laryngectomy tube is the patient's new airway) Term When not to do postural drainage Definition unstable condition Term postural drainage Definition bed position determines lobe; patient position tells you what segment Term postural drainage lobes Definition flat bed, upper lobes; elevated slightly middle lobes; high bed is lower lobes (basal segments) Term postural drainage how is the patient positioned Definition rotate the patient where would you be percussing, that is where located (i.e. flat on stomach, posterior because back facing up or turned to the left would be right side up therefore right side Term Good basic cough Definition deep breath followed by forceful exhalation Term PEP - positive expiratory pressure Definition applying positive expiratory pressure mask using one way valve; flow resistor, resists exhalation and creates back pressure, 15-20 min intervals, 3-4 times per day patients with lots of secretions Term Flutter valve Definition weighted ball, blow in lifts ball up and air escapes which changes pressure and ends up fluttering and creating vibrations inside and mobilizes secretions - simple, mobile Term autogenic drainage Definition breathing exercises - changing volumes (little breath, big breath) free Term external percussive device Definition vibrating vest - expensive Term IPV Definition Intrapulmonary percussive ventilation - machine used to mobilize secretions Term Modifying CPT Definition considerations in percussion for pediatrics and neonates - size of thorax, fear, positioning; duration of therapy will depend upon patient need and/or tolerance; presence of chest tubes, fractured bones; treatments should be scheduled prior to and coordinated with chest physical therapy Term Purpose of suctioning Definition patent airway, specimen collection, stimulate cough Term Indications of suctioning Definition accumulated secretions, obstructed airway, depressed cough, inability to swallow Term Hazards of suctioning Definition trauma to mucosa (most common), lubricate catheter, use gentle technique; contamination (use aseptic); hypoxemia (leading to tachycardisa, arrythmia - most severe); bradycardia (vagal nerve stimulation) Term Suctioning procedure Definition vigorous suction can cause bleeding; 100% O2 pre and post is required, lasting 1-2 minutes; ECG is important to detect problems caused by iatrogenic hypoxemia; sterile catheter and sterile solution and sterile gloves each time; section ET tube first and then mouth; change catheter after suctioning mouth, then suction ET tube Term What are factors affecting the rate of evaporation and resulting in absolute humidity Definition temperature - increased temp increases rate of evaporation; pressure - indirect relationship with rate of evaporation; surface area - direct relationship with rate of evaporation; time - amount of time gas is exposed to all these other factors Term What are the goals of humidity therapy Definition pervention of mucosal crusting, compensate for humidity deficit Term What is insensible water loss Definition water lost from the lungs and skin, breathing, sweating Term What can happen if improper humidity is not maintained Definition thickened secretions and heat loss through evaporation Term What are hazards of humidity therapy Definition possible contamination of source Term Aerosol as foreign object in lower airways Definition can increase airway resistance, cause coughing and cause bronchospasm Term What is the effect of particle size on aerosol Definition larger particle size, higher in respiratory tract the particle will deposit - therapeutic size is 1-10 microns Term What effect does ventilatory pattern have on aerosol deposition Definition major effect, optimum pattern is slow deep inspiration with an inspiratory hold and passive exhalation, pt should breathe slowly through mouth Term What are goals of aerosol therapy Definition relieve bronchospasm and mucosal edema, thin tenacious secrtions, humidify respiratory tract, administer drugs Term what are hazards of aerosol therapy Definition bronchospasm (bronchodilator is the tx), secretion swelling and a/w obstruction (tx is suction); fluid overload in CHF renal failure and infants, tx is monitor I&O and wight; cross contamination (large volume heated aerosol) Term When is a passover or bubble humidifier typically used Definition in conjuction with infant vents and circuits, least effective in humidifying an artificial a/w unless heated Term Suction vacuum pressure ranges Definition adult 100-120 mm Hg (20 mm range for child and infant) Term Procedure for adjusting pressure range on vacuum regulators Definition adust with tubing occluded Term What type catheter would you use to suction left ain stem bronchus Definition Coude tip catheter because it has a special angle Term When would want to use closed suction system catheter Definition allows patient to receive ventilation ad oxygenation during suctioning, so it is indicated for patient with high oxygen and or PEEP requirements. Term what should the external diameter of the suctino catheter be Definition ideally no greater than 1/2 the inside diameter of ET or TRACH tube. Formula is ID size/2x3 Term What are common modifications of suctioning Definition changing size and type (if having difficulty, using a coude catheter is used to suction left bronchus, changed to closed system: , alter negative pressure; instill irrigating solutions, alter frequency of suctioning (PRN ONLY), alter duration (15 seconds is max) Term Suction troubleshooting Definition check catheter for patency, assure vacuum system is working, change or empty full collecton bottle, check all connections Term when to use bubble humidifier Definition delivering oxygen with nasal cannula or simple mask Term HME when to use Definition in the vent circuit between wye and patient - patient transport and short-term ventilation Term Wick humidifier when to use Definition low risk of cross-contamination, delivers 100% body humidity; heated humidifier used in ventilators used with artificial airway. Term HME how much humidity Definition does not delivery 100% humidity, transport and short-term ONLY Term HME and aerosol therapy Definition must be removed during therapy Term Heated wire circuits Definition wires inside circuit, heats tubing so that the water remains evaporated as a gas to the patient. Term nebulizer Definition produces particles and not humidity Term Jet nebulizer Definition small nebulizer used for medication delivery Term large volume nebulizer Definition used to deliver bland aerosols to the upper airway to decrease the chances of edema or humidty deficit Term troubleshooting large volume jet nebulizer Definition no aerosol coming out in inspiration or expiration - INCREASE THE FLOW Term What is a SPAG Definition small particle aerosol generator - used for ribavirin - goes along with scavenger system which captures particles so others don't inhale Term scavenger system Definition goes with SPAG, removed drugs not inhaled by patient Term ultrasonic (electronic) nebulizer Definition high output - used for someone with tenacious secretions because has highest output of aqueous solution - can overhydrate Term what is adjusted on ultrasonic nebulizer Definition amplitude and not frequency (which is set at factory and determines particle size) amplitude would adjust amount of particles Term DPI Definition dry powder inhaler - similar to MDI but does not contain propellent Term MDI Definition metered dose inhaler - shake, mix, fine mist means working, patient must do properly, use spacer to make work better. Spacer helps overcome coordination problems. Term modifications of humidity therapy Definition change type of equipment - ultrasonic nebulizers are used to help tin out thick secretions; change dilution of medication; adjust temperature of aerosol - if thick secretions occur; check temp on jet nebulizers (98.6 or 37); modify patient breathign patterns - if tingling in fingers or lighheadedness make sure pat rate is slow with inspiratory hold; change aerosol output - if unable to see ist increase flow meter setting or add a tandem setup (bleed in system of additional flow) Term Sympathomimetic (Adrenergic) responses - alpha, Beta1, Beta2, Beta2 agonist Definition alpha - vasoconstriction of arteriolar smooth muscles (most blood pressure meds); B1 - heart; B2 lungs therefore most respiratory drugs; B2 agonist = bronchodilator Term Beta Sympathomimetic - aka front door bronchodilators Definition levalbuterol (xopenex); albuterol - ventolin/proventil; metaproterenol - alupent/metaprel; terbutaline - brethine/bricanyl; btolterol - tornalate; pirbuterol - maxair; salmeterol - servent Term What are side effects of beta adrenergic bronchodilators Definition tachycardia; palpitations; hyper/hypo tension; headache, tremors and shakes; paradoxical hypoxemia; tachyphylaxis (lack of response to drug over time); nausea/vomiting - any of these occur, stop therapy notify nurse/doctor, chart results - check dosage then frequency Term Anticholinergics or parasympatholytics - back door bronchodilators Definition atropine sulfate; iptratropium bromide - atrovent; tiotropium bromide - spiriva; glycopyrrolate - robinul; oxitropium bromide - oxivent Term xanthine drugs - side door bronchodilators Definition thophylline, oxytrphyllin; inhibor drug that indirectly increases cAMP which cuases bronchodilation, narrow range of safety, blood levels important to monitor Term what are signs of xanthine toxicity Definition tremors, nausea and vomiting, nervousness, tachycardisa Term mucolytic agents Definition acetylcysteine - mucomyst; dornase alpha - pulmozyme Term side effects of mucolytics Definition bronchospasm, incompatibility with antibiotics, nause and vomiting, airway obstruction - must be given with bronchodilator Term asthmatic prophylactic agents Definition inhibit histamine release; cromolyn sodium - intal; nedocromil - tilade - prophylactic for asthma and will not help in an attack Term corticosteroids Definition anti-inflammatory, immunosupressive, bronchodilating effect, used judiciously - status asthmaticus and asthmatic bronchitis - "sone" drugs and brand names like flovent, budesonide, solu-medrol Term side effects of corticosteroids Definition adrenal suppression, hypertension and oran cadidiasis, treated with anti-fungal,to prevent rise with water after tx Term decongestants Definition mucosal vasoconstrictors, alpha effect causing vasoconstriction and reduced blood flow, treats subglottic edema and post extubation swlling - racemic epinephrine - vapoephrine; ; anti-histamine - interfere with histamine release Term drug sequence order of administration Definition beta 2 (albuterol); anticholinergic (atrovent); steroid (azmacort) Term Leukotriene modifiers Definition non-steroid drug used for prophylactic asthma - zafirlukast - accolate; zileuton - zyflo; montelukast - singulair Term Cardiac drugs Definition cardiac glycosides - tx CHF, atrial tachy and fibrilation - examples are digitalis and digoxin, side effects of nausea, vomiting, headache , arrhythmias, pvcs; anti-arrhthmics - qunidine, propranolol for atrial arrhythmias; ventricular would be lido, procainamide, verapamil, amiodarone; brady would be atropine or epi Term vasoactive drugs Definition vasodilator used to decrease BP like diuretics - thiazides; sympatholytics - direct vasodilators; vasopressors (alpha adrenergic) norepinephrine, dopamine